By Mary Alice Murphy

At the beginning of the Gila Regional Medical Center on Oct. 27, 2022, Chair Alicia Edwards announced the recognitions of two hospital employees for their years of service to the facility. Eddie Garcia was recognized for five years of service in facilities and Ciye Yniguez for 15 years of service in Emergency Medical Services.

Chief Nursing Officer Melanie Vigil noted the Daisy Award that received several nominations of nurses for going beyond their usual duties in taking care of patients, with one of them being chosen. To read more about it, please visit https://www.grantcountybeat.com/community/community-news/74795-extraordinary-nurse-recognized-at-gila-regional-medical-center

Vigil read the letter that cinched the award for Daisy Award recipient, Jennifer Thurnherr. Edwards said that all the letters of nomination were equally glowing. "Without our nurses, we wouldn't have a health care system. They are the backbone."

All the board members, including Chris Ponce, Harry Browne, Javier "Harvey" Salas, Billy Billings and Edwards went into executive session.

After returning out of closed session, and with no new business, the members considered the new business section of the agenda.

The first item addressed the credentialing of providers, with recommendations from the Medical Executive Committee. In executive session, Dr. Colicia Meyerowitz had presented the findings of the MEC.

Board members approved the credentialing as presented, with Ponce abstaining, because he had arrived late to the executive session and the meeting.

On changes to the medical staff bylaws and rules, the board members approved the changes as presented in closed session, with the exception of keeping a section rather than eliminating it at this time. "When legal finishes scrutinizing it, the issue will come back to the board to eliminate the section," Edwards said.

Board members approved two items together, a physician employment agreement and an on-call agreement with Louis J. Melendez. MD, as an employed general surgeon.

Board members approved a professional services agreement with Michael Durando, MD, as a locum tenens medical oncologist for the Cancer Center. Interim Chief Executive Officer Greg Brickner explained that Durando would have to be credentialed and get his New Mexico medical license before coming on board.

Under consideration, a first amendment to a physician retention agreement and a first amendment to a physician employment agreement with Roberto Carreon, MD, as orthopedic surgeon, were approved by the board members. Brickner said the amendments clarified language in the agreements. Carreon will also continue at Southwest Bone and Joint Institute.

Two locum tenens agreements for PRN (pro re nata,—as needed) physicians with two different agencies – Barton and Associates and Weatherby Healthcare, were tabled as the redlined agreements had not arrived on time.

Chief Financial Officer Patrick Banks talked about the first amendment to an anesthesia services agreement with Clinical Colleagues, Inc. "This amendment can include up to seven years on the contract. It aligns our interests to replace CRNs during the period." Members approved the amendment.

Banks also explained the software license and support agreement for a fetal monitoring system with PeriGen. "This is for the Women's Center and will be supported into next year as we continue construction and renovation of the maternal and child department."

Members approved the purchase of capital equipment, including installation of a powered ambulance cot and heart monitor/defibrillator from Stryker in the Osage ambulance. Banks said the hospital bought one ambulance with most of the equipment, but the Osage ambulance comes without the needed equipment. "This purchase is paid for through the USDA grant."

A renewal agreement with IBM "Elite" storage service through PC Connection, Banks explained, is for older equipment. "We are asking for a one-year extension as we move to newer equipment. We are looking for a three-year agreement. This is a bridge to get us to the new equipment." Members approved it.

An additional purchase of capital equipment from Nutanix Hardware and Acropolis Pro License and support for EHR (electronic health records), also through PC Connection, was approved.

Using USDA funding, the members approved the capital equipment purchase of a portable ultrasound system from Mindray via the Vizient GPO (group purchasing organization) for the emergency department. 'We're excited to get it," Banks said.

Also with USDA funding, the hospital is purchasing an electrotherapy system for outpatient rehabilitation from Performance Health via the Vizient GPO. Members approved the purchase.

Edwards asked how far along the hospital was in expending the USDA funding.

"This will finish it," Banks said. "We have about $70,000 unspent for some equipment that is not here yet."

Members also approved a professional services contract for monthly marketing, advertising and community education with SkyWest Media. "This formalizes our relationship with this contract," Brickner said.

Billings asked if the hospital had any measurable results from what SkyWest has been doing.

Brickner said SkyWest "helps us follow where we get our social media contacts and such. They help us with educational videos. We have done three so far. One with Dr. Norman Ratliff (cardiologist), another with Karen DeGenevieve (Cancer Center nurse practitioner) and a third with our new radiation oncologist Dr. Hayostek. We are also doing press releases."

Ponce said: "I'm happy you're doing this with SkyWest. It's been long overdue. I appreciate what they've done."

Edwards echoed it with "It's been a long time coming."

Two resolutions made changes in the signatory authority, one for banking and one for contracts and other documents. "We will remove Mike Lieb, but at this time, I don't think we need to add Scott Manis. We have three signatories, Patrick, Browne and me," Brickner said.

Members approved the two resolutions.

Ponce asked if there were any way for the "our chair to be a signatory without waiting for a governing board meeting?"

Banks said he would be happy to look into it. "We also have internal and robust controls. Two signatures are required on documents. We will work on it."

The final resolution addressed authority to bind insurance policy renewals. "Our underwriters do not release the policy documents until late in the process, so if you approve this it covers that we have the authority to approve the renewals." Members approved the resolution.

Next came reports.

CNO Vigil expanded on the description of the Daisy Award. "It is given once a year. We receive nominations from colleagues, staff, patients and their families. The committee meets throughout the year. The form can be filled out online for a nurse that provides extraordinary care. We receive them in real time. Jennifer was recognized by several nominations. Our nurses are our heroes every day."

Vigil reported that the Level IV Trauma Director Roberta Berry has served in the position since it was established in 2019. "They have treated 1,299 trauma patients since then. The No. 1 cause of trauma is falls. So, we are implementing the Helping Hand program, so we're all on the same page inside or outside the organization. We collaborate with the university. We are working closely with the nursing class graduating in December. We are doing interviews with them right now."

She announced the Trunk or Treat, which took place on Halloween. "We have a competition between departments on best costumes and best decorations."

Edwards said she did the math on the trauma numbers, and they average more than one a day.

Vigil said 51 percent of trauma patients are older than 65 years. "We provide education to the patient and the family after an event."

"On wound care management, do you have plans to make sure seniors don't come back?" Edwards asked. "To reduce the numbers."

Vigil said the hospital always works on a safety environment to prevent it from happening again. "We want to identify the risks."

Edwards notes that nearly 40 percent of the residents of Grant County are living below the poverty line. "They have rickety steps. If you identify risks at home, how are you addressing these risks?"

"Sometimes, they can't return home," Vigil said. "They go with families and repairs are made so they can return home."

Edwards said it can be a serious problem "for our seniors. It needs to be top of mind."

Banks presented the financial report for September. "The volume trends are steady. Melanie manages the plurality of the staff. The volumes reflect that. They are pretty steady for most departments. The ER sees more year over year. We expect about 1,450 to come to the ER. It's a place that requires talent and we need to make sure everyone gets the best training."

He reported EBIDA (earnings before interest, depreciation and amortization) at $350,000. "If we can keep it up, we can fund our own projects. For our directors and managers, we made sure to recruit for full-time employees, not contract employees. We have spent $2.8 million on contract labor since the beginning of the year. This month it was $600,000. Our cash on hand is tracking better since we became a critical access hospital. We had a large payment when we paid down our accelerated Medicare loan that we got during the pandemic."

There was no report from the Chief of Staff, Dr. Brian Robinson.

Chief Quality Officer Ramona Wilson said: "Our goal is to meet the needs of our patients and their families. The Press Ganey survey asks: 'Would you recommend Gila Regional Medical Center?' Our goal is to have 90 percent recommending GRMC. We're at the 54th percentile. We can reach our goal with quality care."

She noted three common things that affect the scores: Patients don't get it right for discharge; they don't get their choice for a meal; and the rooms are cold or hot or noisy or cluttered or need cleaning.

"Valerie Johnson, our patient liaison, follows up within 7 days with patients' concerns and those who leave the ER without being seen," Wilson said. "74 percent of our staff has been vaccinated for the flu. Our goal is 85 percent."

Billings asked what she did to encourage staff to get the vaccination.

"We have pop-ups on their screens, and we have a lot of marketing within our organization with posters and flyers and such," Wilson replied.

On the patient scores, Edwards noted that it's hard for a patient to retain information given to them, if they are scared or worried.

"We make sure our communication is getting through," Wilson said. "Each team needs to continue the patient's care plan. Each patient gets a care plan before their discharge. If it's not achievable, their care will go out the window. We have the care plan available in English and Spanish."

Edwards said the seven-day window for complaints seems a bit long. "I think a timely communication is an important part of quality. If I was concerned about something, seven days is a long time to hear back. And do you have staff to get to the seven-day goal?"

Wilson said: "Valerie calls all patients within 72 hours. In house, the concern is addressed in real time. The 72 hours is for those who are not in the hospital. We meet every Thursday. We may not issue a letter immediately. We may need an investigation. Sometimes she reaches out more than once, depending on the issue."

Compliance Officer Denice Baird said the hospital is required to issue a form and the person can report anonymously. "We also have a toll-free anonymous number. September had no complaints through the hot line. For 2020, we have 0.8 complaints per hundred encounters. Nationwide it is over 1.5 per 100. We have required all the directors, managers and supervisors to receive training in diversity, equity and inclusion, as well as on sexual harassment. They must complete the training by the end of November. If not, they are removed from the schedule. We award people for reporting near misses and good catches. If a bed alarm doesn't go off, then we look into it. We encourage reporting these issues. Event reporting is 2.4 percent, down a bit from last year to volume. With the decrease our best practices are to push out education on how important safety reports are. They are done in a non-retaliatory environment."

Chief Human Resources Officer Beverly Bush reported the hospital went live with the UKG program on Sept. 24. During the first time-clock punch and first payroll, "we identified a couple of issues, which were quickly resolved. Denice is working one-on-one with the leaders. We will have open enrollment with UKG. Our employment engagement survey is continuing. We are at 56 percent, with a goal of 65 percent participation. Staffing through quarter 1 of fiscal year 2022 last year, we had a 51 percent turnover rate. The 2021 industry was at 26 percent. We will conduct employee merit evaluations. We saw 23 employees transfer to the Lincoln Financial Group from Brighthouse."

Ponce asked if HR had moved from the "dungeon."

Bush said the door is unlocked, but not open. People can come in. "You no longer have to buzz to come in."

Edwards asked why they couldn't just prop the door open.

Brickner said: "You cannot prop doors open in a hospital. Some are magnetic, so if a fire closes it, you can still get out."

Billings asked if 56 percent is a good number for the employee satisfaction survey.

Bush said the goal is 65 percent with 10 days to go.

Billings said: "44 percent haven't taken it. Is there any reason why they are waiting?"

Bush said some may not believe it is anonymous. "We will be educating them that it is."

Salas asked about retirement on 403B.

Bush said a person has to be employed for a least a year and will receive 2.5 percent match up to four years, then it's 5 percent. "They are fully vested, the moment they sign up. They can only take out early what the IRS allows."

Brickner said: "That's one of the reasons why we're the best place to work. They always keep their money, and the hospital employee chooses their investments."

Banks said looking at retirement accounts is scary right now. "At the hospital, we have a low tolerance for risk. We have every option, including a fixed income stream that won't vary with the market."

Brickner said in his report: "We're in a people business. Patrick is helping us recruit and retain. We are striving to have a culture of safety. We are listening to our employees and looking for feedback. Happy, engaged employees do the best work. We have done 14 employee contracts. We are gaining momentum. The notion in the community is that we're not capable of getting providers. We continue to recruit. In the last year 24,000 providers quit nationwide. In the past year, we have spent on capital purchases $6.9 million including grants, capital outlay and our own cash. Each contract becomes a project. Never has this much money come into the hospital in a year. We're digging out of our deficit in capital purchases. For our selection of projects, we have a fluid list, with the top priority of the moment being at the top of the list. For instance, a pneumatic system broke, so that became the priority."

For the Health Tech report, Scott Manis (twice former interim CEO) has been named regional vice president and was present at the meeting to give a report.

"I am honored to be here to represent Health Tech and to see Gila Regional grow and thrive. I've invested time in this hospital. As soon as I drive into town, my heart gets warm. It's a special place to me. I am continuing to be all in. I thank Greg and the leadership team. I like seeing promotions from within the organization. It provides stability.
The permanent CEO search is front and center. We have done interviews this week, and we will be bringing you solid candidates. Secondly, Carolyn St. Charles will be out here next week working on nursing quality. She will be working with Melanie and Ramona and will be talking about the swing bed program. Also, Carolyn is available by text, email or phone. She is very responsive. The last thing I want to talk about is Health Tech in general. It is a company that has been providing a variety of services for more than 50 years. We consult with hospitals and provide interim leadership. Within our services, we provide clinical care, quality, compliance, revenue management, as well as management of supplies and equipment. We have features you need at a fair price, including case management, swing bed counseling and care coordination. We continue to bring those services as part of our management services."

Billing, Salas and Ponce had no board reports. Edwards said: "Our goal is to have a permanent CEO, but from the time Greg left, I hoped he would come back, and he did. It feels to me like we're starting to make progress. I thank everyone who is part of that progress."

The meeting adjourned.